Impact of anesthesia method on cortisol and interleukin-6 concentration changes during and after laparoscopic colorectal surgery

Abstract

Background. The surgicalstressinduced release of hormones, such as ca techolamines (norepinephrine and epinephrine), adrenocorticotropic hor mone (ACTH), and cortisol, via the autonomic nervous system and the hypothalamicpituitaryadrenal axis (HPA) mediates inhibitory effects on immune functions. Pain management may influence the immune response in the postoperative period. The goal of the present study was to examine to what extent postoperative pain management modulates the surgeryinduced alterations of the immune response, specifically, interleukin6, cortisol and C reactive protein (CRP); to compare effects of two pain management tech niques, based on NSAID and continuouos epidural infusion of a local anaes thetic and morphine mixture.Materials and methods. Local Bioethics Committee's approval was re ceived, patients ASA I-III scheduled for laparoscopic colorectal surgery (LCS) were randomised to receive general anesthesia (GA, N = 27) or combined ge neral anesthesia with epidural analgesia (EA, N = 26). Anesthesia was induced with propofol, fentanyl and atracurium and maintained with sevoflurane. The EA group received the first dose of 3 mg epidural morphine with 0.25-0.125% bupivacaine mixture 20-30 min before surgery and continuous epidural infu sion of bupivacaine 0.25% and 5 mg of a morphine mixture for postopera tive analgesia. The GA group received intravenuous fentanyl and morphine during surgery, and NSAID for postoperative pain management. There were 5 cases when laparoscopy was converted to open surgery due to surgery find ings, these cases made the thirdconversion group (CG) with further mainte nance intended analgesia type. Pain was evaluated using the visual analogue scale (VAS) after anaesthesia and 24 hours later. Venous blood samples for cortisol and interleukin6 were taken preoperatively before induction of ana esthesia (baseline), after surgery and 24 hours after baseline. Venuous blood samples for CRP were checked after 1, 2, 3, 4, 6 days after surgery. Collected data were stored in the data base and were analysed using SPSS for Windows Version 19.0. The data were analysed using the MannWhitney U test and Stu dent's t test for comparison of 2 groups and ANOVA for comparison of more than two groups. The Bonferroni adjustment was used to detect pairwise dif ferences between the groups. The Chisquare test was used to determine dif ferences between categorical variables. Differences between the groups were considered statistically significant at p < 0.05. 245Impact of anesthesia method on cortisol and interleukin6 concentration changes during... Results and discussion.There were statistically significant differences be tween the groups in pain score after surgery (p < 0.001) and 24 hours later (p < 0.000) and in bowel motility after anaesthesia (p < 0.001). In EA group bowel motility was observed in 96.2% of patients after surgery and lasted more than 24 hours despite of infusion of local anesthetic mixture with morphine. In the GA group only in 55.6% of cases bowel motility was observed after...

Changes in Serum Levels of Il-6 in the Early Postoperative Period After Preemptive Analgesia With Nimesulide, Metamizole Sodium and Placebo in Removal of Impacted Mandibular Third Molars

“…As in other procedures in oral surgery, because of the relatively small number of studies of IL-6 after extraction of third molars, extrapolation of data from surgical interventions in other fields was necessary. When performing surgery of a larger extent, IL-6 levels are significantly elevated [21]. This shows that we can use the levels of the cy-tokine studied as an early marker of tissue injury, as well as of the extent of the surgery performed.…”

The relationship between anaesthetic technique, clinicopathological characteristics and the magnitude of the postoperative systemic inflammatory response in patients undergoing elective surgery for colon cancer

“…Papadima and co-workers, in 40 patients receiving open surgery for colon cancer, reported a decrease of post-operative day 2 CRP in patients receiving general anaesthesia compared with epidural analgesia [14]. In contrast, Gasiunaite and co-workers, in 53 patients receiving laparoscopic colorectal resection, reported no significant difference in the post-operative CRP concentration on day 2 and 3 in patients receiving general anaesthesia versus general plus epidural anaesthesia [15]. Taken together with the present results in 409 patients and given that the magnitude of the postoperative SIR is greater in open surgery [3], it may be that regional anaesthetic techniques have a greater potential to modulate the magnitude of the postoperative SIR.…”